OSPE cryptococcal meningitis

Question 1

case

Answer 1

fever, stiff neck , splitting headache and vomiting since 2 days.
lost 10 kg in the last one month.
diplopia;
developed seizures and altered sensorium.
less WBC
* Serology for HIV was positive for HIV-1.
* CD4 cell count was 250 .

Question 2

CSF

Answer 2

clear/turbid
increased P
decreased glucose
increased protein
leucocytosis with predominant lymphocytosis

Question 3

Name the special stains you will use in this particular case.

Answer 3

Negative staining : India Ink or Nigrosine dye
* Demonstrates capsule as halo ~ 2/3rd the size of the yeast cells, budding ++

Question 4

Which are the culture media you will use in this case?

Answer 4

• Sabaroud’s dextrose agar : Mucoid , white or Creamy , butyrous colonies seen
• Bird seed agar: Brown melaninised colonies seen
• Concanavine glycine thymol blue agar: Differentiates C.neoformans from C. gattii

Question 5

findings you would expect in RADIOLOGY

Answer 5

• CT scan brain: Soap bubble lesions in the brain consistent with Cryptococcus neoformans infection
• MRI brain: Cryptococcomas

Question 6

microscopy

Answer 6

Gram positive broad base budding yeast cells , No
pseudohyphae

Question 7

Serology

Answer 7

• Blood sample
• Antigen detection: Latex agglutination, Enzyme Linked Immunosorbent Assay, Radioimmunoassay , Immunofluorescence
• Antibody detection: LA, ELISA, RIA, IF

Question 8

Molecular study

Answer 8

PCR